The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Acute Purulent Pericarditis Complicated by Severe Left Ventricular Systolic Dysfunction and Cardiac Tamponade

좌심실 부전과 심낭 압전을 유발한 급성 화농성 심낭염 1예

  • Choi, Su-Jin (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Chung, Woo-Baek (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Kim, Hyun-Jin (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Yim, Sun-Mie (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Choi, Yun-Seok (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Park, Chul-Soo (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine) ;
  • Lee, Man-Young (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea School of Medicine)
  • 최수진 (가톨릭대학교 의과대학 내과학교실 순환기내과) ;
  • 정우백 (가톨릭대학교 의과대학 내과학교실 순환기내과) ;
  • 김현진 (가톨릭대학교 의과대학 내과학교실 순환기내과) ;
  • 임선미 (가톨릭대학교 의과대학 내과학교실 순환기내과) ;
  • 최윤석 (가톨릭대학교 의과대학 내과학교실 순환기내과) ;
  • 박철수 (가톨릭대학교 의과대학 내과학교실 순환기내과) ;
  • 이만영 (가톨릭대학교 의과대학 내과학교실 순환기내과)
  • Published : 2012.02.01
⟨ Previous Next ⟩

Abstract

An 85-year-old male visited our hospital because of dyspnea. Chest radiography showed marked cardiomegaly and pneumonic infiltration. Transthoracic echocardiography showed moderate pericardial effusion, which resulted in effusive constrictive pericarditis and severe left ventricular systolic dysfunction. During the hospital course, the patient developed cardiogenic shock and was treated with an inotropic agent and intra-aortic balloon pump. The patient's vital signs were stabilized after pericardiocentesis and drainage. A yellowish purulent pericardial effusion was drained and Streptococcus pneumoniae was isolated. Bacterial purulent pericarditis was not uncommon before the antibiotics era, but it is extremely rare nowadays. Here, we report a case of purulent bacterial pericarditis presenting with severe left ventricular systolic dysfunction and cardiac tamponade.

호흡곤란을 주소로 내원한 85세 남자 환자에서 폐렴과 동반한 심비대 소견이 관찰되었고, 심초음파 소견에서 중등도의 심낭 삼출액으로 인한 삼출성 협착 심낭염과 중증의 좌심실 부전이 관찰되었다. 입원 경과 중 심인성 쇼크로 진행 하였고, 수축촉진제(inotropic agent) 투여 및 IABP 삽입하여도 쇼크 상태가 회복되지 않았으나, 심낭 천자 및 배액술을 시행한 후 즉시 활력 징후가 안정화되었다. 심낭 삼출액 배양 검사에서 폐렴구균(Streptococcus pneumoniae)이 동정되었다. 항생제 개발 이후 폐렴구균에 의한 심낭염은 매우 드문 것으로 알려져 있고, 좌심실 부전까지 유발하는 경우는 보고된 바가 없었다. 저자들은 급성 화농성 심낭염으로 인하여 중등도 심낭 삼출 및 심낭 압전과 좌심실 부전을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Zayas R, Anguita M, Torres F, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol 1995;75:378-382. https://doi.org/10.1016/S0002-9149(99)80558-X
  2. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol 1985;56:623-630. https://doi.org/10.1016/0002-9149(85)91023-9
  3. Parikh SV, Memon N, Echols M, Shah J, McGuire DK, Keeley EC. Purulent pericarditis: report of 2 cases and review of the literature. Medicine (Baltimore) 2009;88:52-65. https://doi.org/10.1097/MD.0b013e318194432b
  4. Snyder RW, Braun TI. Purulent pericarditis with tamponade in a postpartum patient due to group F streptococcus. Chest 1999;115:1746-1747 https://doi.org/10.1378/chest.115.6.1746
  5. Sagrista-Sauleda J, Barrabes JA, Permanyer-Miralda G, Soler-Soler J. Purulent pericarditis: review of a 20-year experience in a general hospital. J Am Coll Cardiol 1993; 22:1661-1665. https://doi.org/10.1016/0735-1097(93)90592-O
  6. Kan B, Ries J, Normark BH, et al. Endocarditis and pericarditis complicating pneumococcal bacteraemia, with special reference to the adhesive abilities of pneumococci: results from a prospective study. Clin Microbiol Infect 2006;12:338-344. https://doi.org/10.1111/j.1469-0691.2006.01363.x
  7. Tatli E, Buyuklu M, Altun A. An unusual complication of pneumococcal pneumonia: acute tamponade due to purulent pericarditis. Int J Cardiol 2007;119:e1-e3. https://doi.org/10.1016/j.ijcard.2007.02.042
  8. Lee WR. Clinical Cardiology. Seoul: Korea medical book 1998:909-918.
  9. Huh KR, Kim JK, Joo NR, et al. A case of myocarditis and pneumonia caused by Mycoplasma pneumoniae. Korean J Med 2008;75:S898-S903.
  10. Russell JA. Management of sepsis. N Engl J Med 2006; 355:1699-1713. https://doi.org/10.1056/NEJMra043632